This project compares the clinical outcomes and resource requirements of two alternative protocols for the use of dental pit-and-fissure sealants. Current practice is to use pit-and-fissure sealants on the fissured surfaces of most newly-erupting permanent molars, in an effort to ensure that decay will not begin on those surfaces. Because of the decline in dental caries in the US and many other countries, a growing proportion of the surfaces that are sealed in this way would not have developed caries, even without the sealants. There is concern that the placing of sealants on an ever-increasing number of teeth that may never have decayed in the first place constitutes unnecessary treatment and an inappropriate use of resources. The project compares the current approach to one which uses sealants only as a non-invasive, conservative intervention on incipient lesions, but does not place sealants on sound teeth. The result of this research will provide the necessary information to allow more cost-effective use of this highly efficacious procedure. The two protocols will be compared in a prospective three-year trial to be conducted in selected Indian Health Service clinics. One group of 2,000 children will be treated according to the current IHS protocol, which encourages the use of sealants on virtually all sound fissured surfaces in children. Another 2,000 children will receive sealants only on suspected early lesions. After three years, the clinical outcomes and resource requirements for the two alternatives will be compared.